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In the middle of the decade
  1. J S Smolen
  1. Correspondence to:
    Professor J S Smolen
    EULAR President, Medical University of Vienna, and Lainz Hospital, Vienna, Austria; josef.smolenwienkav.at

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Hopes for a change of the European Union’s approach to the rheumatic diseases … and more!

A decade—how quickly it passes! The Bone and Joint Decade—proclaimed by the United Nations and by the World Health Organisation for the years 2000–2010 and underwritten by dozens of governments world wide—has already reached its mid-term. How great! More than 5 years of “our” decade! A reason to celebrate? Not really. What are the achievements hitherto? Have rheumatic diseases gained more public awareness than in the 1990s? Have there been significant advances in disability legislation? Have governments set aside special funds or increased grant support for research into musculoskeletal disorders?

The decade before the Bone and Joint Decade was dedicated to the brain and these were the goals set forth in a proclamation by President George Bush designating the 1990s as the Decade of the Brain: “to enhance public awareness of the benefits to be derived from brain research” through “appropriate programmes, ceremonies, and activities”.1 “The annual budget of the National Institute of Mental Health, the major American funder of neuroscience, more than doubled over the past decade to nearly $1 billion.”2

Worldwide funding for neuroscience research was increased, brain research institutes were founded or expanded, and the European Union allocated more than €1.3 billion for “combating major diseases” in its Research Framework Programme 6 (FP6),3 with significant funds allocated to “studying the brain and combating diseases of the nervous system.”4

What are the major diseases in FP6?—cancer, diabetes, neurological diseases, infectious diseases, and cardiovascular diseases. And where are musculoskeletal disorders? Not in the picture.

It is of special interest that a renowned cardiologist called antirheumatic drugs “lifestyle medications” in a recent editorial5—as if rheumatic diseases were “lifestyle” diseases. What then are atherosclerosis and most cardiovascular disorders? Are lupus and scleroderma not life-threatening diseases? Is rheumatoid arthritis not associated with increased mortality?6 Is osteoarthritis not associated with significant disability?7 Do hip fractures due to osteoporosis not cause high mortality?8 And is disability from rheumatic diseases—the biggest cause of disability, sick leave, and disease associated early retirement—a “lifestyle” problem and less serious than disability from other causes?

“Are we merely dealing with ‘lifestyle’ diseases?”

For a long time rheumatic diseases have been neglected by officials and public opinion leaders. Nevertheless, rheumatology has been at the forefront of scientific innovations in the basic and clinical sciences over the past 10–15 years.9

The burden that musculoskeletal disorders impose on the individual patient and society in health and the economic terms and the scientific foundations set up in recent years call for an increase in research efforts that can only be met by appropriate funding. The European governments must foster and make such efforts, and the European Commission, in particular, must meet these needs in the seventh Framework Programme. Musculoskeletal disorders deserve to be regarded as “major diseases” and receive appropriate funding in FP7, and this funding also ought to compensate for the deficiencies of the past.

EULAR, the organisation of the European scientific and patient societies, has continued to and will increase its activities in the context of its “Alliance Against Arthritis” (AAA), with actions in Brussels and throughout Europe.

A “Declaration on Arthritis” has been prepared, which will be submitted to the European Parliament with the support of parliamentary members. Signatures from a large number of members of the European Parliament (MEPs) will be required to make this Declaration highly visible and effective throughout Europe, and we call on all European organisations representing people with arthritis, or rheumatologists to persuade their countries’ MEPs to sign this Declaration.

Together we can make sure that the neglect of rheumatic diseases will become history.

In the middle of the Bone and Joint Decade this is more than timely. And by the end of this decade we must have “enhanced public awareness of the benefits to be derived from arthritis research through appropriate programmes … and activities”. By the end of this decade we should have achieved further advances in research that lead to an improvement in the treatment and quality of life of people with musculoskeletal conditions and look towards a bright future for our specialty.

Hopes for a change of the European Union’s approach to the rheumatic diseases … and more!

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